Lifestyle Changes, Fad Diets
and Dietary Supplements:
What Works, What’s Worthless and What’s New!
Dr. Moyad, MD, MPH
VOLUME: 1, ISSUE 1
The most overrated, overpriced, and overhyped
supplement of the year is RESVERATROL!
Bottom Line:
Do not spend your money on this
trials in obese men and
supplement until it proves it can actually do something
non-obese
besides make your wallet or purse lighter. Drink red wine
showed
(contains resveratrol from grape skins) or white wine in
supplement is not
moderation to enjoy better benefits right now compared to
really doing anything
resveratrol dietary supplements.
for general health.
that
And—worse
What else do I really need to know? SRT501,
women
the
news—
at the time I was
research
[...] found in a
small clinical trial
that resveratrol
supplements might
block the healthy
benefits of
exercise!
a resveratrol-like compound, was being developed by
writing this newsletter,
a pharmaceutical company and was estimated to cost
new research from the
only $750 million (sarcasm alert), and was supposed to
Journal of Physiology found
be promising, especially in the area of cancer. It failed
in a small clinical trial that
to show a benefit in a multiple myeloma clinical trial,
resveratrol supplments might block the healthy
and there was a lot of toxicity. Other recent, small clinical
benefits of exercise!
The most overrated and overhyped dietary clinical trial of
the year is PREDIMED Mediterranean Diet Study.
Bottom Line:
A Mediterranean diet compared to
What else do I need to know?
Researchers
a Mediterranean diet with less olive oil, nuts, and fatty
decided to evaluate the potential impact of a Mediterranean
fish (so called “low-fat” or “control” diet) appeared to
diet in a primary prevention trial of individuals at high risk for
significantly reduce the risk of stroke in those with a high
a first cardiovascular event (for example, a heart attack or
cardiovascular risk, but it did not appear to reduce the risk
stroke). This was a multicenter randomized trial from Spain.
of dying younger from any cause (cancer…) compared to
Individuals actually followed 1 of 3 diets:
the control diet. WHAT?! This is correct! What does this
mean? How about a free advertisement for extra virgin
olive oil and nuts! Actually, what it really shows is that there
are plenty of different diet plans that can work for you.
And, what you should know is that if you can
1. the Mediterranean diet with extra-virgin olive oil,
2. the Mediterranean diet with mixed nuts, or
3. a control diet (“low fat”) where participants were
encouraged to reduce fat intake and to consume less
olive oil, nuts, and fatty fish.
reduce your blood pressure, then you can almost
The primary end point was major cardiovascular events
immediately reduce your risk of having a stroke.
(myocardial infarction, stroke, or death from cardiovascular
disease). A total of 7447 individuals were enrolled (57% were
women), and the trial was stopped after the interim analysis
end point in the 2 Mediterranean diet groups compared to the
and after a median follow-up of 4.8 years. Average age of
control group. This was primarily due to a significant reduction
participants was 67 years (range, 55 to 80 years), and average
in the risk of stroke (33% to 46%; P =0.04 and P =0.006). There
waist circumference was 39 to 40 inches (for men and women),
were no significant differences between the Mediterranean
>90% were overweight or obese (about half obese and half
diet groups and the control group in other end points such
overweight), and only 8% had a normal BMI (scary stuff).
as myocardial infarction or death from cardiovascular or any
Approximately 80% of participants had high blood pressure,
cause, but nonsignificant trends favored the Mediterranean
70% had bad cholesterol numbers, and half had diabetes.
diet. Most subgroups studied appeared to benefit, especially
These individuals were NOT HEALTHY!
those with hypertension, dyslipidemia, and/or obesity. A
Mediterranean diet with increased consumption of extra-virgin
A significant reduction (28% to 30%) occurred in the primary
olive oil or nuts reduced the risk of major cardiovascular events.
OKAY…Now that was a more partially politically correct version of this study!
Let’s take another look at this study.
Here is your very basic Mediterranean diet that was used in this study (and below is my sarcastic but accurate
commentary that you did not hear much about after so many “experts” were drooling over these results):
Extra-Virgin Olive Oil (≥ 4 tablespoons/day) Note:
Olive oil has 120 calories/tablespoon, which means
participants were getting, in some cases (others were just getting 1 more tablespoon), at least 480 calories/day
from olive oil, which makes it impossible to lose weight or waist, and that is one reason why most individuals did not
lose weight! Olive oil was provided for free by a local olive oil company to the Mediterranean diet groups but not to
the control group. If you provide something for free to people, especially in terms of food, you are more likely to eat it
regularly. In many ways, this diet study was a free advertisement for olive oil, and many of the researchers had multiple
financial relationships with nutritional or food companies.
Tree nuts and peanuts, but especially walnuts, almonds, and hazelnuts (≥3 servings/week)
Note: Why mostly walnuts, almonds, and hazelnuts? It was because they were also provided to the participants at
no charge on a regular basis. Hey, free olive oil and nuts on the house for years if you are in the Mediterranean diet group
but not for the control group. Wow! This sounds like a wonderful free advertisement for extra-virgin olive oil and nuts!
Fresh Fruits (≥ 3 servings/day) Note: This makes sense for many diet plans.
Vegetables (≥ 2 servings/day) Note: This makes sense for most diet plans.
Fish (especially fatty fish) and seafood (≥ 3 servings/week) Note:
This
makes
sense
for most diet plans.
Legumes (≥ 3 servings/week) Note: This makes sense for most diet plans.
Sofrito (≥2 servings/week) Note: This is a sauce that is made with tomato and onion and often includes garlic
and aromatic herbs, and it is simmered slowly with OLIVE OIL! More olive oil? Yes, and the olive oil was, once again,
provided for free.
White meat Note: This makes sense for most diet plans, especially when using lean meats.
Wine with meals (optional, ≥7 glasses/week) Note: This is not going to help participants lower their weight or
waist and, in some cases, it does not allow for blood pressure reduction, but at least this adds some fun to the diet plan!
Stay away from the following as much as possible: Soda drinks, commercial baked goods, sweets, pastries,
spread fats, and red and processed meats. Note: This makes sense for most diet plans.
The LOW-FAT group was instructed to eat low-fat dairy
pressure in the Mediterranean diet probably explain why it
products, bread, potatoes, pasta, rice, fruits, veggies, and
worked so well to reduce the risk of stroke. Yet, what you
LEAN FISH (not omega-3–rich fish) and seafood. They
should really walk away with from this study is that a diet
were discouraged from consuming vegetable oils including
with multiple healthy eating patterns is a healthy direction,
olive oil, nuts, fried snacks, fatty fish and seafood canned
but weight reduction is also critical for enormous success.
in oil, red and processed meats, visible fats in meats and
None of the groups lost weight! So, the suggestion,
soups, spread fats, and sofrito.
it appears, is that you can eat all the olive oil and nuts
SO, THIS IS NOT A LOW-FAT DIET BUT STILL
you want and you will not gain weight if you are already
A HIGH-FAT PARTIAL MEDITERRANEAN DIET
obese because these foods make you feel satiated. Yet,
that puts individuals at a disadvantage, especially
the control group eating far more carbohydrates (no limits
when trying to lower their blood pressure from
on pasta, bread, potatoes, rice, etc) did not gain weight
these foods.
either. I could argue that the study would have been
stopped in just 1 to 2 years, and the researchers would
There
and
now be candidates for the Nobel Prize if one group would
disturbing about this clinical trial. It was interesting in
is
something
simultaneously
interesting
have lost a lot of weight on a diet and dropped their blood
terms of helping to confirm that a Mediterranean diet
pressure, cholesterol, and blood sugar. And, had weight
that encourages more daily olive oil or nuts per day can
loss occurred in the control group, I bet there would have
reduce the cardiovascular risk of individuals at high risk.
been no difference among any of the diets.
Yet, the study was disturbing for many reasons
Look, I love the Mediterranean diet
because participants were SO UNHEALTHY
OVERALL in terms of their basic health
more than a football team that beats
[The main
measurements, such as weight and
Notre Dame, Michigan State, and
number of medications being taken.
Ohio State in the same year.
take-away] is
However, I do not like it when a
that a diet with
The study was also disturbing
Mediterranean diet gets credited
multiple
healthy
in the way it was subjectively
for working better than a low-fat
construed or biased by many
or another type of diet when
eating patterns is a
“experts”
and
even
these
this was really just a deceptive
healthy direction, but
researchers in terms of definitive
study to suggest that you
weight reduction is
proof that the Mediterranean diet
need to get more extra-virgin
is the best dietary intervention,
olive
oil and nuts in your diet!
also critical for
and that other diets such as low-fat
Did I just suggest that this was a
enormous
diets do not work as well. WRONG!!
biased dietary study for commercial
success.
The low-fat comparison group was
purposes? NO COMMENT! (Hey, I
getting 39% of their calories from fat at the
feel more like a politician every single
beginning of the study, and at the end of the
day.) Here is my advice: eat a Mediterranean
study, it had decreased to only 37%, which is still a high-fat
diet, lose weight and waist (if needed), and lower your
diet (average American diet is 33% FAT)!!!
blood pressure, cholesterol, and blood glucose (again, if
needed).
In addition, the Mediterranean diet group received
personalized attention and advice throughout the trial and,
for the first 3 years, the control group did not. Then the
study was changed to also give some personal attention
to the control group.
So, what has been learned? Getting more extra-virgin
olive oil and/or mixed nuts is healthy as long as significant
weight gain does not occur, and reductions in blood
Exercise daily and stay away from tobacco,
and the Mediterranean diet will provide much
better results compared to what occurred in this
overhyped study that got the nation’s attention for
a few hours!
FISH OIL FLOPS 3 Times (AREDS2, Italian, OPERA)!
Bottom Line: 1000 mg of omega-3 (EPA 650 mg
treatment of dry eye syndrome.
+ DHA 650 mg) added nothing to the current eye
If you are perfectly healthy,
formula (eg, Ocuvite, the original by Bausch and Lomb
there is no proof you
with vitamin E, C, zinc, and copper) already shown to
need to take fish oil
reduce the progression of macular degeneration. Fish
right
oil did not reduce the risk of a cardiovascular event
being addressed in an
(heart attack, stroke, etc) in those at high risk for such
ongoing study in the
an event, nor did it reduce the risk of atrial fibrillation
U.S. called “VITAL,”
after surgery when used in really large dosages.
but for now many
now.
This
is
folks do not need fish
What else do I need to know?
oil. Fish oil does not
Fish
oil does not
appear to reduce
the risk of atrial
fibrillation better
than does a placebo,
especially after
having
surgery.
There is no need to add fish oil to your macular
appear to reduce the
degeneration or eye health supplement right now
risk of atrial fibrillation
because it is not doing anything. The only eye health
better than does a placebo,
supplement that should contain fish oil is one for the
especially after having surgery.
Beta-carotene supplements are bad
for smokers (current and former)
Bottom Line: Former and current smokers simply
smokers taking beta-
should not take any dietary supplements with beta-
carotene supplements,
carotene in them because it can increase the risk of lung
and both studies
cancer. Food sources of beta-carotene are safe, and it
showed a significantly
is only the supplement that appears to be increasing
increased risk of lung
this cancer risk.
cancer in smokers
both
studies showed
a significantly
increased risk of
lung cancer
in smokers
taking these
supplements.
taking these supplements.
What else do I need to know? Two older and
However, now it appears even
very large definitive clinical trials, known as ATBC and
ex-smokers may be at risk for lung cancer if they take
CARET, both tried to show a lower risk of lung cancer in
beta-carotene dietary supplements.
Lutein/zeaxanthin might be good for eyes if you do not get
enough from food!
Bottom Line:
Adding 10 mg of lutein
and 2 mg of zeaxanthin to your eye health
formula if you have macular dengeration
might be a good idea. Kale and egg yolks
are my favorite large dietary sources of
lutein and zeaxanthin. In this clinical trial,
researchers also found lutein and zeaxanthin
appeared to have no impact on cataract risk.
Kale and
egg yolks are
my favorite large
dietary sources
of lutein and
zeaxanthin.
What else do I need to know?
These 2 compounds are being studied to
improve skin health, but for now, it appears
they may be able to improve eye health
in terms of preventing the progression of
macular degeneration when added to a
traditional eye health supplement.
Scaring people for what reason? Omega-3 and
prostate cancer?
Bottom Line: Medicine is like a courtroom where the
of the cholesterol blood test), relieve dry eye, and help with
verdict is decided by the preponderance of evidence. This
joint pain in some individuals. Otherwise, I do not believe
study adds very little to the evidence and simply made
fish oil supplements do much of anything else right now.
exaggerated conclusions based on blood work from a
study of vitamin E and selenium. Fish consumption is
What else do I need to know?
associated with a lower risk of cardiovascular disease and
comes out that scares you or goes against the norm of
arguably several cancers including prostate cancer. Fish oil
nutritional thinking, take several weeks to investigate the
supplements can lower abnormally high triglycerides (part
merit of the study before you toss out your supplements
When a study
or add any new supplements based on just one study.
Vitamin C and Kidney Stones…Hurts So
Good (John Mellencamp, circa 1982)?
Bottom Line: Vitamin C in high doses (≥ 1000 mg/day)
Vitamin C
in high doses
(≥1000 mg/day)
probably increases
the risk of a
kidney stone.
probably increases the risk of a kidney stone. The result
What else do I
need to know?
of this study translates into 1 new kidney stone per 680
This was a group of
high-dose (≥ 1000 mg/day) vitamin C users per year. This
23,355 men who had
is not a small number so if you are worried about kidney
never had a kidney stone.
stone risk with vitamin C, take a lower dosage (≤ 500 mg)
After 12 years, men taking
or switch to a pH neutral or buffered vitamin C (calcium
vitamin C were twice as likely
ascorbate), which, from preliminary results, carries fewer
to develop a stone compared to those who did not use
side effects and may not have the same risk of kidney
this supplement. Although it did not prove cause and
stones compared to plain vitamin C.
effect, there has been enough research on vitamin C over
the last 50 years to suggest these results are accurate.
Best Dietary Company/Product of the Year! SO DELICIOUS!
Bottom Line:
“So Delicious” dairy-free brand of
What else do I need to know?
chocolate ice cream with coconut milk had only 100
The So Delicious company calls them “coconut milk frozen
calories per serving (half a cup), 10 grams of fiber, and 1
desserts” and the chocolate (no sugar added)-flavored
gram of sugar…and tastes great! Try it! You should like it!
100-calorie-per-half-cup product is arguably the best!
If you do not like it, then just go back to regular chocolate
Peruse their Web site and see what you can find! Yummy!
ice cream.
Best Diet Product of the Year that allows you to you take
fewer pills? BARLEAN’S OMEGA SWIRL!
Bottom Line: Why even take a fish oil pill anymore, if
(Moyad, circa 2013)! They have a new high-potency
you believe in them, when you can take only 2 teaspoons
“omega swirl” with only 60 calories/tablespoon and 1500
of Barleans Omega Swirl and take in <50 calories? Or take
mg of omega-3 fish oil! Wow! And, their regular omega
only 1 tablespoon of their new high-potency product (60
swirl has about 45 calories and 720 mg of omega-3 from
calories), which is basically the equivalent to 1 to 2 fish oil
fish oil, and it is also high in omega-9 oleic acid (same
pills, without ever tasting that fishy taste? You will actually
omega-9 or monounsaturated fat found in olive oil). They
think it tastes like a desert! And, it can arguably be taken
have amazing flavors, such as lemon zest, key lime, mango
straight or added to most foods.
peach, and pina colada…and they have kids’ products!
If you do not want fish oil (comes usually from cod and
What else do I need to know?
salmon), you can get their omega vegan swirl or one of
It is the best-tasting fish oil product I have ever tasted
their flaxseed oils!
Multivitamin Surprise (Centrum Silver Study) or PHS2 Study.
Bottom Line: Take a Centrum Silver or something close
to it in formulation and price for the prevention of cancer,
or an adult can take a children’s multivitamin because the
Centrum Silver used in this study was not exactly the same
one sold today, and the dosage is somewhat similar to a
children’s multivitamin today. Below was the formula of
the product that was used for this study, which began in
the 1990s (compare this to your multivitamin)*:
Men
[...] appeared to
There were no
reduce the risk of
women in this
being diagnosed with
study (only a
study of primarily
cancer by ≥8% when
really healthy male
taking a Centrum
physicians), but there
Silver daily
is plenty of reason to
believe women should
vitamin ...
What else do I
need to know?
Vitamin A=5000 IU
(50% as beta-carotene)
Vitamin B12=25 µg
Copper=2 mg
Vitamin C=60 mg
Biotin=30 µg
Manganese=3.5 mg
Vitamin D=400 IU
Pantothenic acid=10 mg
Chromium=130 µg
Vitamin E=45 IU
Calcium=200 mg
Molybdenum=160 µg
Vitamin K=10 µg
Iron=4 mg
Chloride=72.6 mg
Vitamin B1=1.5 mg
Phosphorus=48 mg
Potassium=80 mg
Vitamin B2=1.7 mg
Iodine=150 µg
Boron=150 µg
eating >5 servings/day of fruits and veggies appeared
Niacin=20 mg
Magnesium=100 mg
Nickel=5 µg
to benefit compared to those with a diet that was not as
Vitamin B6=3 mg
Zinc=15 mg
Vanadium=10 µg
adequate. Men with a parental history of cancer did not
Folic Acid=400 µg
Selenium=20 µg
Silicon=2 mg
appear to benefit as much in this study.
*Note: IU=International Units, mg=milligrams, µg=micrograms (also
symbolized by “ug” on some supplement containers), UM=University
of Michigan (just thought I would throw that in to see if you were still
paying attention), PU=symbol or saying for what someone says when a
skunk is sleeping under your living room couch (again, just seeing if you
are still paying attention).
also follow the results of
this study. Men with and without
a personal history of cancer appeared to reduce the risk
of being diagnosed with cancer by ≥ 8% when taking a
Centrum Silver daily vitamin compared to a placebo. The
side effects were similar to those of a placebo. Even men
Older men (70+) appeared to get more benefit in
terms of cancer reduction compared to younger
men (50+).
cardiovascular health in this study? I am glad I asked myself
So, it passed the Moyad test of being safe for the
heart. So, for pennies a day, it is possible to reduce your
this question. A total of 27 men died from a heart attack
risk of being diagnosed with cancer regardless if you are
in the Centrum group and 43 died in the placebo group (P
really healthy and fit or not. I was shocked at how critical
=0.05). When this group was further analyzed, it appeared
some bone-headed alternative and conventional medical
that men with no personal history of cardiovascular disease
“experts” acted when this study was released! Some
had a 44% significant (P =0.56) reduction in the risk of
conventional folks argued the results were not impressive
dying from a heart attack compared to those on placebo
enough, and some alternative experts suggested a different
(22 vs 39 deaths). Men with a history of cardiovascular
multivitamin would have had a better result! What a bunch
disease did not have an increase or a decrease in the risk of
of Monday morning quarterbacks!
However, what was the impact of Centrum Silver on
dying from a heart attack with the multivitamin compared
to placebo (5 vs 4 deaths).
Centrum Silver should be applauded and rewarded for
being in this study because they risked their entire business
Does this mean Centrum Silver reduces the risk of
dying from a heart attack? Not really, because there
by being a part of this research because, had something
were not enough heart attacks in this study to prove
would have been on that same table in the bookstore
cause and effect, but there were enough cardiovascular
where former scandalous best-selling books that hit #1 on
events (stroke, death from heart disease, etc) to show that
the NY Times Best Sellers list are a few years later that
the multivitamin did not increase or decrease the risk of
sell for $0.99. In other words, you couldn’t have given
cardiovascular disease overall.
this supplement away if something went wrong. Kudos to
gone wrong, then the #1 selling multivitamin in the U.S.
Centrum Silver!
Best/Most Awesome References:
• Popat R, Plesner T, Davies F, et al. A phase 2 study of SRT501 (resveratrol) with bortezomib for patients with relapsed and or refractory multiple
myeloma. Br J Haematol 2013;160:714-717.; • Poulsen MM, Vestergaard PF, Clasen BF, et al. High-dose resveratrol supplementation in obese
men: an investigator-initiated, randomized, placebo-controlled clinic trial of substrate metabolism, insulin severity, and body composition. Diabetes
2013;62:1186-1195.; • Yoshino J, Conte C, Fontana L, et al. Resveratrol supplementation does not improve metabolic function in nonobese women
with normal glucose tolerance. Cell Metab 2012;16:658-664.; • Gliemann L, Schmidt JF, Olesen J, et al. Resveratrol blunts the positive effects of
exercise training on cardiovascular health in aged men. J Physiol 2013; July 22: epub ahead of print.
• Estruch R, Ros E, Salas-Salvadóo J, et al, for the PREDIMED Study Investigators. Primary prevention of cardiovascular disease with a
Mediterranean diet. N Engl J Med 2013;368:1279-1290.
• Age-Related Eye Disease Study 2 Research Group. Lutein + zeaxanthin and omega-3 fatty acids for age-related macular degeneration; the AgeRelated Eye Disease Study 2 (AREDS2) randomized clinical trial. JAMA 2013;309:2005-2015.; • Risk and Prevention Study Collaborative Group.
N-3 fatty acids in patients with multiple cardiovascular risk factors. N Engl J Med 2013;368:1800-1808.; • Mozaffarian D, Marchioli R, Macchia A,
et al, for the OPERA Investigators. Fish oil and postoperative atrial fibrillation: the Omega-3 Fatty Acids for Prevention of Post-Operative Atrial
Fibrillation (OPERA) randomized trial. JAMA 2012:308:2001-2011.
• Age-Related Eye Disease Study 2 Research Group. Lutein + zeaxanthin and omega-3 fatty acids for age-related macular degeneration; the AgeRelated Eye Disease Study 2 (AREDS2) randomized clinical trial. JAMA 2013;309:2005-2015.
• Age-Related Eye Disease Study 2 Research Group. Lutein + zeaxanthin and omega-3 fatty acids for age-related macular degeneration; the AgeRelated Eye Disease Study 2 (AREDS2) randomized clinical trial. JAMA 2013;309:2005-2015.
• Brasky TM, Darke AK, Song X, et al. Plasma phospholipid fatty acids and prostate cancer risk in the SELECT trial. J Natl Cancer Inst 2013; July
10: epub ahead of print.; • Szymanski KM, Wheeler DC, Mucci LA. Fish consumption and prostate cancer risk: a review and meta-analysis.
Am J Clin Nutr 2010;92:1223-1233.
• Thomas LD, Elinder CG, Tiselius HG, Wolk A, Akesson A. Ascorbic acid supplements and kidney stone incidence among men: a prospective
study. JAMA Intern Med 2013;173:386-388.
sodeliciousdairyfree.com
www.barleans.com
• Gaziano JM, Sesso HD, Christen WG, et al. Multivitamins in the prevention of cancer in men: the Physicians’ Health Study II randomized
controlled trial. JAMA 2012;308:1871-1880.; • Sesso HD, Christen WG, Bubes V, et al. Multivitamins in the prevention of cardiovascular disease
in men: the Physicians’ Health Study II randomized controlled trial. JAMA 2012;308:1751-1760.